Healthcare Provider Details

I. General information

NPI: 1124653761
Provider Name (Legal Business Name): DINA BORICHEVSKIY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 J ST
SACRAMENTO CA
95819-3626
US

IV. Provider business mailing address

8108 HIGHWOOD WAY
ORANGEVALE CA
95662-3130
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-6421
  • Fax:
Mailing address:
  • Phone: 916-832-6383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95014483
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number799861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: